Soumission

Table of Contents

Executive Summary
Issue
Background
The Breastfeeding Coalition of Newfoundland and Labrador
Recommendations for Infant Feeding
Value of breastfeeding
Risks of not breastfeeding
Rates of breastfeeding in Newfoundland and Labrador
The interaction of employment and breastfeeding
Women's stories
The need for paid breastfeeding breaks in the workplace
Recommendation #1
Recommendation #2
The impact of paid breastfeeding breaks
Conclusion
Bibliography

Executive Summary

The Breastfeeding Coalition of Newfoundland and Labrador recommends that legislated paid breastfeeding breaks be included in the upcoming revisions to Part III of the Canada Labour Code. This is in line with the International Labour Organization (ILO) standards for maternity/ breastfeeding protection which call for paid breastfeeding breaks.

Breastfeeding is an unequalled way of providing ideal food for growth and development of babies. There is evidence of the benefits of breastfeeding and evidence of risk of not breastfeeding for babies, mothers, families and society. Although 62.7% of women start breastfeeding, this rate drops to 27.5% at 6 months.

Being employed does impact on breastfeeding practice. A majority of mothers is employed outside the home. Women have cited "return to work/school" as the third highest reason for stopping breastfeeding.

Improving the rates of breastfeeding initiation and duration requires many strategies including policy, education, and supportive environments. Having legislated paid breastfeeding breaks is a systems change in the workplace that requires collaboration among various groups including employers, employees and government departments. Along with education and awareness, this policy can help create a positive environment so mothers can choose to continue to breastfeed when they return to work.

Issue

The Breastfeeding Coalition of Newfoundland and Labrador proposes that paid breastfeeding breaks be included in the upcoming revisions to Part III of the Canada Labour Code. This is in line with the International Labour Organization (ILO) standards for maternity/ breastfeeding protection which call for paid breastfeeding breaks.

Background

The Breastfeeding Coalition of Newfoundland and Labrador

The Breastfeeding Coalition of Newfoundland and Labrador was formed in 1991 and includes professionals and the public interested in the promotion of breastfeeding. Our purpose is "to protect, promote and support breastfeeding in Newfoundland and Labrador" with the ultimate goal of making breastfeeding the cultural norm. The Coalition's objectives are to: support the implementation of the Baby Friendly JInitiative within the province; facilitate information sharing about breastfeeding promotion, research, resources, recommendations and practice; and advocate for the promotion, protection and support of breastfeeding.

Recommendations for Infant Feeding

In 2004, Health Canada released its recommendation for exclusive breastfeeding of babies for the first six months of life with sustained breastfeeding and introduction of appropriate complementary foods until the child is two years of age or older. (1) Exclusive breastfeeding means that a baby receives only breast milk and no other foods or liquids. The Health Canada recommendation is in line with that of the World Health Organization.

Value of breastfeeding

Breastfeeding benefits babies, mothers, families and society in general. Breastfeeding provides many benefits to babies which include:

1. protection against gastrointestinal infections, otitis media, allergies, respiratory infections (2,3)
2. less risk for postnatal death (2)
3. less risk of asthma (3)
4. less risk of developing juvenile onset diabetes, Type 2 diabetes, obesity, cancers and heart disease in later life (3)
5. improved cognitive development and neurological development, including visual development (3,4)
6. decreased incidence and severity of allergies. (5)

Breastfeeding provides benefits to mothers and families which include:

1. less risk of breast and ovarian cancers and osteoporosis. The report of the Collaborative Group on Hormonal Factors in Breastfeeding (2002) determined that breastfeeding could result in a significant reduction in women's risk for breast cancer. (6) The longer women breastfeed, the greater is the protection against breast cancer.
2. less expense to families because they do not have the cost of formula (5)
3. faster recovery after childbirth. (3)

The benefits to society include:

1. decreased social costs of morbidity and mortality (5)
2. healthier children which makes for healthier adults in the future
3. decreased health care costs (3)
4. reduced use of resources and pollution in manufacture and transport of infant formula and reduced garbage in the disposal of infant formula containers.

Risks of not breastfeeding

There are risks for infants who are not breastfed. These include:

1. more visits to physicians offices, more hospitalizations and more prescriptions for respiratory tract illness, otitis media and gastroenteritis (7)
2. increased risk of obesity for children and adolescence with increased risk of diabetes, hypertension, stroke and gallbladder disease (8)
3. risk of exposure to contaminated formula. (9,10)

Rates of breastfeeding in Newfoundland and Labrador

In Newfoundland and Labrador, there has been an increase in the initiation of breastfeeding over the past 20 years. In 1983, 31.9% of women initiated breastfeeding (11) with 62.7% of women initiating breastfeeding in 2003. (12) However, 62.7% is the lowest initiation rate among the provinces and territories in Canada. Furthermore, the duration rate at 6 months is 27.5 % at 6 months, with 11.1% exclusively breastfeeding at 6 months. These statistics tell us that we are living in a culture where breastfeeding is not the norm.

The interaction of employment and breastfeeding

Topic IV of "Modernizing Federal Labour Standards" Consultation Paper identifies balancing work and family responsibilities as an issue for Canadian families. Maternal employment, especially without workplace policies and support for breastfeeding, is one obstacle to initiation and continuation of breastfeeding. (3) Women with young babies who return to full time work outside the home tend to breastfeed for shorter durations and have lower rates of exclusive breastfeeding. (13) Canadian women identified "Return to work/school" as the third highest reason (14%) for stopping breastfeeding. (2) This is significant in light of these statistics:

• an increasing proportion of women of childbearing age are employed outside the home. (13) Nationally, 72% of wives with children are employed; 60% of these have children under age 2. (14) Sixty seven percent of single females with children are employed; 31% of these have children under age 2.
• the median time at home for Canadian mothers who are eligible for maternity/parental leave is 10 months. (15) Over 80% of employed mothers in 2000 and 2001 returned or planned to return to work within 2 years.
• women with lower wages tend to return to work earlier than those with higher earnings.

Minimal enabling conditions such as breastfeeding breaks and facilities for expressing and storing breast milk can help women to continue breastfeeding. (3,16)

Women's stories

Women have various experiences with returning to work and breastfeeding. Here are some of their stories, as written by the women.

Story #1

First of all I should say that I have breastfed all four of my children successfully after returning to work six months to a year in some cases after their births. I remember my first experience the best as being the most challenging as my first born (David) was five and half months old when I returned to a full time job. Some of the logistics that I had to sort out before returning included: regimenting David's schedule to meet when I would be available. This meant nursing hurriedly before I ran out the door, offering cereal and a sippy cup mid morning, rushing home noon for my lunch and nursing him on my lunch break and then in the evening when I arrived back home.

Returning to a full time job at this time meant: introducing my baby to solids before I felt he or I was ready. I was really stressed that he would be hungry while I was gone and this made me feel really stressed at work as I worried about him constantly.

In my case, the need to be at work "on time" caused me a lot of anxiety. I always had this feeling of guilt if I was a little late for work or returning to work and I felt a lot of pressure to tailor my baby's needs to my hours of work. This was especially challenging when the baby was less than eight months of age. New moms in shift work situations would have many more obstacles to face in this case.

With my third and fourth child, I had a year's leave which really took many pressures off me with regards to the nursing. Being a professional in demand, I was permitted to work very part time when it was suitable for me. This worked extremely well as I earned some extra income while being off and the employer and the community got a service that otherwise would not be available. This flexibility in work hours also allowed me to put my baby's needs first.

Some things that I feel need to be considered in regards to nursing and work include: the year leave verses six months certainly alleviate the issues surrounding early weaning that a lot of women face when they must return to work prior to a year. Any legislation that would be supportive of moms staying home longer would increase how long women continue to breastfeed. Also allowing moms to earn more money during maternity leave over a two year period verses one would also help support new moms economically and allow maximum flexibility in the workforce.

Secondly offering flexibility in work hours i.e. coming in at 8:30 verses 8:00, longer lunches if necessary mutually agreed upon by the employer and employee would also help.

Flexibility acknowledged by the employer is the key I feel. This is essential as the needs of every mom and baby at different stages of the breastfeeding experience are so unique. You may need only an extra few minutes here and this relieves a lot of pressure off the family unit in order for this to work.

I congratulate you on giving these issues voice!

Best Regards
Jo Anne Mallay-Jones

Story #2

I nursed both my children. My first child I nursed till she was approximately 8 months old. However I did return to work when she was 5 months old. During this time I started out by pumping milk to have on hand just in case the formula did not satisfy her. After the first couple of weeks my nursing began to wind down. I would nurse her in the morning before I would go to work and I would also nurse her at bedtime. This continued for a couple of months till she no longer wanted to.

My Second child I nursed till he was 8 months old. He was born in May and I returned to work in January. By the time I returned to work I was probably just nursing him at nighttime. This time it seemed much easier to wean as he was older when I went back to work.

Name withheld, by request

Story #3

As the mother of a new baby one of the things I wanted to do most for my child was provide her with a good start. Breastfeeding was one of the ways I knew I could do this. In 1997 the maternity benefits under the Employment Insurance Program lasted for approximately six months. I had hoped to nurse my little girl for a year.

I returned to work after eight months after having exhausted all my leave. I did commit to expressing breast milk in the day in order to keep a supply for her. This meant pumping at my desk during lunch hour and sometimes throughout the afternoon while I was on the phone. Fortunately for me my employer allowed the use of the refrigerator to store the milk and my colleagues were supportive of my efforts to do this.

My success was due to the fact that I was in an environment that supported breastfeeding. This was by chance, not by design. Policy that would create workplaces that are supportive to breastfeeding would ensure that every baby has the opportunity to be their best right from the start.

Colleen Kearley
Spaniard's Bay, NL

Story #4

My beautiful baby daughter was born in March of 2000. I breastfed her 100% of the time while I was on Maternity Leave from my job. Before I knew it, the six-month Maternity Leave was coming to an end and I was left wondering how I could continue to give my little girl, in my opinion, the best milk - breastmilk.

I started to make pumping off breastmilk a part of my nightly routine. After my baby was settled in for the night, I'd pump my breastmilk into disposable nurser bags which I would then seal and freeze. I built up mini stockpiles of frozen milk over the last few weeks of my Maternity Leave.

I returned to my job at my workplace in September 2000. While there, my baby was fed my thawed and warmed breastmilk in a bottle by her babysitter during my working hours, but breastfed as usual by me outside of work hours. Luckily, my baby didn't refuse the bottle feeding and my daughter got breastmilk nearly 100% of the time up until she turned one year of age, when I started gradually weaning her off of it. This is how I coped with breastfeeding while also working outside my home.

Jennifer H.

The need for paid breastfeeding breaks in the workplace

In the context of the value of breastfeeding and the culture of breastfeeding within the province, the Breastfeeding Coalition of Newfoundland and Labrador advocates for paid breastfeeding breaks as a strategy to protect, support and promote breastfeeding.

Recommendation # 1: Legislation: to include paid breastfeeding breaks into the revised Canada Labour Code Part III.

Legislation is needed to protect the time and space to breastfeed. This can be done by incorporating the International Labour Organization standards for breastfeeding breaks into the Federal Labour Code in Canada. (16l) The International Labour Standards for Maternity Protection establishes a woman's right to breastfeeding breaks and protects that right to breastfeeding time, space and support in the workplace. (17)

Breastfeeding protection was a fundamental component of maternity protection when the International Labour Organization (ILO) was founded in 1919. In June 2000, the ILO adopted a revised Convention 183 and Recommendation 191 on Maternity Protection.

• Non-discrimination: Convention 183 says that maternity (including breastfeeding) should not constitute a source of discrimination in employment or in access to employment. Furthermore, the Convention makes it unlawful for an employer to fire a woman during pregnancy, maternity leave or for a period following her return to work, except on grounds unrelated to maternity.
• Employment protection: A mother returning to work is entitled to the same job and salary as before her leave.
• Maternity leave: The minimum length of paid maternity leave is 14 weeks.
• Breastfeeding/Nursing breaks: After maternity leave, women workers who are breastfeeding have the right to paid breastfeeding/nursing breaks or a reduction of work hours. A breastfeeding break is paid time during the work day when a breastfeeding mother either breastfeeds her child or expresses her milk.

What facilities and how much time are needed for breastfeeding or expressing milk in the workplace?

ILO Recommendation 191 says, "where practicable, provision should be made for the establishment of facilities for breastfeeding under adequate hygienic conditions at or near the workplace." (18)

Basic cleanliness, accessibility and security are the most important features of a breastfeeding space. A breastfeeding employee needs access to a small, clean space with room to sit down and a door, screen, or curtain for privacy, and access to clean water. The level of cleanliness is similar to that needed for preparing or eating food, thus, the bathroom is not appropriate. A worker needs to know that the space will be available when she needs it. More than one mother can use the space at the same time, if all agree. In fact, they may find it helpful for mutual encouragement.

If a mother is expressing her milk, she needs a secure storage place for milk, which can either be space for a container at her work station or another secure storage place. The milk can be safely stored for 4 to 10 hours at room temperature, or stored in a refrigerator or in a cool, insulated box or thermos container.

Recommendation 191 states that "the frequency and length of nursing breaks should be adapted to particular needs". Thirty minutes is a reasonable break time to allow for either nursing a baby or expressing milk with some flexibility allowed.

Recommendation # 2: Non-legislative support: Collaborate with Health Canada and the Public Health Agency to build a strong educational foundation to support positive cultural attitudes to legislated paid breastfeeding breaks.

Legislating paid breastfeeding breaks is a policy initiative, and as such, it is one of several strategies to promote breastfeeding. When making any change, there is a greater opportunity for success when more than one strategy is used. Therefore, along with this policy, there needs to be other strategies: education of employees and employers; increased awareness; and a supportive environment.

This can happen as a collaborative effort among the Federal Departments of Labour, Health and the Public Health Agency to develop strategies for education that support breastfeeding as the cultural norm in Canada. Legislation will be more effective if it is supported by educational and media approaches that protect, promote and support "breastfeeding as a smart strategy for working parents" as outlined in the Baby Friendly Initiative in Community Health Services: a Canadian Implementation Guide. (19)

The Federal Labour Department will be responsible for enforcement of these changes to the Canada Labour Code.

The impact of paid breastfeeding breaks

Having paid breastfeeding breaks allows mothers the opportunity to choose to breastfeed and return to work, rather than thinking that they must wean their baby when they return to work or trying to figure out how they will continue breastfeeding and return to work. Sustained breastfeeding makes a positive impact on mothers, babies, families, workplaces and health care system. Mothers, babies and families can experience the benefits of breastfeeding and avoid the risks of formula feeding as described on pages 2-3. Paid breastfeeding breaks can result in benefits for employers:

• less staff turnover and loss of skilled workers after the birth of a child (5)
• reduced time off work for mothers and fathers of breastfeeding babies because their babies are more resistant to illness
• lower health care costs associated with healthier, breastfed infants
• higher job productivity, employee satisfaction and morale
• reputation as a company concerned for the welfare of its employees and their families.
• awareness that breastfeeding is a normal way to feed babies.

Conclusion

One objective of the Breastfeeding Coalition of Newfoundland and Labrador is to advocate for the protection, support and promotion of breastfeeding. The Coalition recognizes legislating paid breastfeeding breaks as one strategy to support breastfeeding mothers and that this strategy will be more successful when combined with other strategies and when various stakeholders work together in a collaborative approach.

Bibliography

1. Health Canada (2004). Exclusive Breastfeeding Duration, 2004 Health Canada Recommendation.
2. Statistics Canada (2005). Breastfeeding Practices. Health Reports Vol. 6 No. 2, 23-31.
3. American Academy of Pediatrics (2005). Breastfeeding and the Use of Human Milk. Pediatrics 115; 496-506. Accessed at www.pediatrics.org/cgi/content/full/115/2/496.
4. INFACT Canada. (no date) Exclusive Breastfeeding: Vital to Baby's Health. INFACT flyer.
5. Breastfeeding Task Force of Greater Los Angeles (no date). Economic Benefits of Breastfeeding. Breastfeeding Works. Accessed at www.breastfeedingworks.org/econ.htm
6. Collaborative Group on Hormonal Factors in Breast Cancer (2002). Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet 360 (9328): 187-95. Available www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd
7. INFACT Canada (no date). Breastfeeding and Food Security: The High Cost of Formula Feeding. INFACT flyer.
8. INFACT Canada (no date). Enough is Enough - Obesity and Formula Feeding. INFACT flyer.
9. Gurtler, J.B. et al. (2005). Enterobacter sakazakii: A coliform of increased concern to infant health. International Journal of Food Microbiology 104 (1): 1-34. Accessed at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed& list_uids=12133652&dopt=Citation
10. Mayor, S. (2004). FAO/WHO meeting warns of contamination of powdered infant formula. BMJ 328: 426.
11. Neonatal Screening Program, Janeway Child Health Centre, St. John's, NL
12. Statistics Canada (2003). Breastfeeding practices, females aged 15 to 55 who had a baby in the previous five years, Canada, provinces, territories and peer groups, 2003. Accessed at http://www.statcan.ca/english/freepub/82-221 XIE/2004002/tables/html/2178_03.htm
13. Rea, MF and AL Morrow (2004). Protecting, promoting and supporting breastfeeding among women in the labor force. Advances in Experimental Medicine and Biology 554: 121-32. Accessed at http://www.ncbi.nlm.nih.gov.hsl-proxy.mun.ca/entrez/query.fcgi?cmd=Retrieve& db=pubmed&dopt=Abstract&list_uids=15384572&itool=iconabstr&query_hl=8
14. Sauve, R. (2002). CONNECTIONS - Tracking the links between jobs and family. The Vanier Institute of the Family . Accessed at http://www.vifamily.ca/library/cft/connections.html
15. Statistics Canada (2003). Benefiting from extended parental leave. The Daily March 21, 2003. Accessed at http://www.statcan.ca/Daily/English/030321/d030321b.htm
16. WHO/UNICEF (2003). Global Strategy for infant and young child feeding. Geneva: World Health Organization.
17. International Labour Organization (2005). C183 Maternity Protection Convention, 2000. Accessed at http://www.ilo.org/ilolex/cgi-lex/convde.pl?C183.
18. International Labor Organization (2005). R191 Maternity Protection Recommendation, 2000. Accessed at http://www.ilo.org/ilolex/cgi-lex/convde.pl?R191.
19. The Breastfeeding Committee for Canada (2002). The Baby-Friendly^TMInitiative in Community Health Services: A Canadian Implementation Guide. Toronto: Breastfeeding Committee for Canada.

Contact Information
Donna Nolan, co-chair
Eastern Health
P.O. Box 70
Holyrood, NL
A0A 2R0
709-229-1575
donnanolan@hcse.ca